When UNC Health and Cigna failed to reach a contract agreement, 60,000+ North Carolina patients were left scrambling. But the deeper lesson isn’t just about one health system — it’s about how downcoding, administrative overload, and payer tactics are threatening revenue and continuity of care nationwide. This post breaks down the real risks, early warning signs, and how providers can proactively protect their revenue and patients before their own contracts are at risk.
A growing pattern of automated E/M reductions is appearing across multiple states, and most practices won’t see the losses until the month-end numbers don’t add up. Your E/M payments may already be shifting.
Unless a new agreement is made, UNC Health will be out-of-network for Cigna commercial plans starting December 1. I, like over 60,000 other North Carolinians, have just over five weeks to find a new primary care provider.
When Cigna Healthcare's R49 policy made headlines in October 2025, many assumed it was an isolated case. Cigna Healthcare then paused the policy due to regulatory pressure. The relief was short-lived. The trend didn't stop; it had already spread to nearly every major insurer in the country.
Running a healthcare business may cause you to want to handle billing in-house. This method provides comfort, control, and saves on outside service costs.
Jun 224 min read
In fact, one healthcare provider we worked with achieved 132% of monthly collection goals.
⚠️ Is Your Practice at Risk?
Book a complimentary 15-minute contract risk call this week.
I'll help you identify:
✓ Hidden revenue leaks in your payer contracts
✓ Downcoding exposure you might not see
✓ Early warning signs of contract breakdown
